I said “out of curiosity” not to be coy, but because our British National Heath Service (NHS) is free on the point of delivery. A few hundred pounds (about $500) come out of my pay check each month based on my income level and I never pay a cent more. No co-pay. No deciding whether I can afford a treatment. Or wondering whether my insurance will cover it. That’s it. Simple and free on the point of delivery.

My doctor cocked his head and said breezily, “£100,000.” That’s $164,000, not including the six-week hospital stay, 24-hour nursing and on-going care that will last the rest of my life.

“What!” was my flabbergasted response. Even with my monthly deductions, I could never pay into the NHS what I have already taken out of it.

This is what insurance should be: a safety net. I was a perfectly healthy 40-year old when I unexpectedly contracted leukemia. I didn’t know I would need the NHS, but I invested nonetheless. And when I did need it, I received excellent care.

But, can the same be said for Obamacare? Is it simple? Free on the point of delivery? Moreover, does it make people feel more secure?

I was reminded of the difference between healthcare pre-Affordable Care Act and now from an article in Reuters. You may know that pre-ACA many women were denied coverage because they were pregnant, but did you know you could be denied coverage for being an expectant father? How about a firefighter, police officer, patient with asthma, acne, allergies or toenail fungus?

Toenail fungus?

As ludicrous as this sounds, insurance companies are taking further advantage of post-ACA coverage by raising the cost significantly for families. Two families I know paid dearly for pregnancy related charges. In one, their policy doubled in price to cover maternity (among other things) because ACA requires maternity coverage even though they specifically looked for a plan without it originally. In another, their policy doubled when their baby was born.

Again, I’m flabbergasted. But, I shouldn’t be so surprised. According to Time Magazine, “America spends 19% of its gross domestic product on healthcare. The rest of the developed world spends around 11% to 12%.” But spending almost twice as much does not mean America’s health care is better, in fact in almost every outcome – from infant mortality to how long patients wait to see doctors – America fares worse than other developed countries.

Personally, I think health care should be a basic human right. But, I’m not sure market-driven care is the best way to go about it.

Recent posts

No, we are not. The ACA does not help our family. We pay for healthcare through my husband’s employer. It is expensive, but good coverage (especially for what we have used/had so far). Here is the thing, because we are offered healthcare through an employer that automatically disqualifies us for any subsidies or discounts offered or touted by the ACA. Also because of the ACA our healthcare cost will be increasing this year and next year for sure. This makes it even more expensive and the % it is going up is more than inflation and any annual cost of living raise that my DH might receive. Also while the ACA does offer more coverage (i.e. dental) it is more expensive for us and our healthcare plan is grandfathered in so they so not have to offer us the same benefits/coverage. It is frustrating to hear so many politicians and people talk about how great it is, when we live on a small budget (I mean we qualify for a lot of gov. aide, but don’t take it) and people say “Oh the ACA is made for the middle, lower and below poverty classes.” When in actuality if they were to try to figure this out in our shoes, they would see how tempting but unreachable/unaffordable it is. This is just my personal example. I also have friends and family who will be paying 300-500% more for their healthcare because their current providers have canceled their policies. Some people don’t understand that an extra $300-$500 (or more) a month is just not doable for some families, especially in a “you have three months” kind of tie frame. It has been very stressful.

Stacie Lewis

Sorry it has been so stressful Irishmama7. In the first example I used of a family I know, the mom told me her husband just received a pay rise which they were jubilant about until they realized the whole thing would go towards paying the higher premium. So you aren’t alone.

Irishmama7

*time frame

Julius

I don’t think it’s fair to insinuate that insurance companies are “taking advantage” by raising rates. They are complying with the law. What are they supposed to do go bankrupt. Everyone assumes greed, but these are the very real consequences of the law. If it was so great you wouldn’t have seen so many small insurers leave the insurance market since Obamacare was passed.

If someone become pregnant and then goes out to buy coverage for pregnancy than that is kind of cheating the underwriting system. (For more information on how underwriting workshttp://www.snopes.com/politics/soapbox/kinder.asp) It is perfectly legal, but now that pre-existing conditions have to be covered than people can wait until they have a costly medical need and buy coverage. Than the costs will be very high.

The ACA has a provision that if the insurance companies lose too much money, the taxpayers will have to pay for it–reimburse insurance companies. In a sense the insurance companies were greedy–thinking that this law would bring themire customers paying for higher cost plans, but if it doesn’t work than taxpayers have to pay for it. They were greedy for signing up for this gig, not for raising rates to comply.

People look at prices and assume someone is greedy if they think that it is too high, but in a free market if people aren’t willing to pay for something than their greed drives them out of business.

I work for a small company that has never offered health insurance. And my husband is self employed so we have always bought our own health insurance. We had a high deductible plan with an HSA and we got another high deductible plan with HSA. The deductible is $6000 more than what we had but we will only ever have to pay out that amount. With that said the only time we have ever met our deductible anyway is when we had our child. We are not having anymore kids so unless we get really sick we won’t use the deductible anyway. We are paying with the subsidy $150 less a month than what we were paying before Obamacare. So I am really not that ups at about it right now. If we had to pay more and were getting less coverage I would be really mad. There are things I think are great with Obabmacare such as the not being denied for preexisting health conditions. And not maxing out health benefits. I think that Obama had great intentions but when he had to deal with congress a lot of things got changed and added.

Leah

I agree Obama has great intentions and at least took the step of moving our country toward health care for all, because the U.S. sucks at that.

I also agree about companies totally taking advantage of ACA as an opportunity to raise premiums. It’s pathetic – as if they weren’t rich enough

Jane

My husband and I own our own business and buy our own insurance. Until January 1st 2014, we could not purchase our own insurance and have it cover maternity. No insurer in our state will allow you to purchase a personal policy and cover maternity. (A business plan requires us to have more employees which we don’t have). We are expecting a baby and yeaaa we’re covered.

And, yes, the multi billion dollar insurance companies are working this right now. No question.

This will all sort itself out, the same way Medicare did. What would my elderly parents do without Medicare? They’ve had strokes and cancer. No private insurer would ever cover them. We live in the best country on earth and send billions overseas. No Anericzn should be told their cancer caused them to hit their lifetime max or lose their job and insurance, only to find that 2 months later their “préexisting condition” won’t be covered!

Stacie Lewis

So pleased to hear that you have insurance to cover your pregnancy. I still find it shocking that women were forced to go without before given the risks involved in birth to both mother and baby (and of course, I hope you have a safe and easy birth!). Like you, I hope the next year or so will smooth the whole thing out. Medicare is a good example of what can work.

If you want to believe health care companies are greedy and make lots of money, than that is your belief and you are entitled to believe it. The facts show otherwise. Willfully ignoring the facts is not a great way to go if you really want to improve health care.

Amanda

America fares worse when it comes to wait times to see doctors? I have a hard time believing that. And you aren’t sure market-driven care is the best way to go about things? Wouldn’t removing the profit motive from the healthcare industry completely stifle innovation? Drug companies, medical device companies, researchers, etc. aren’t going to come up with new treatments just out of the goodness of their hearts. Personally, I think that President Obama views the ACA as merely a step on pathway to a federal takeover of healthcare. The fact that the federal government can’t even put together a decent website in 3 years should make Americans very nervous about that, though. Do your really want these power hungry, incompetent people in charge of the entire industry?

One of the major, major problems with American health care that the ACA didn’t take care of was the fact that hospitals basically charge whatever the heck they want. $20 for a Tylenol? Sure. And don’t forget to tack on $40 for the nurse who got it for you. I applaud the ACA, in its efforts to take care of those who need it. But I don’t think a complicated insurance exchange was the way to go.
s
What they should have done was expand Medicaid and Medicare, and give people who are under 65 the option of buying into Medicare at cost and-a-bit (something like $700/person/year, if WaPo is to be believed–but even if it is a bit higher, I doubt it would cost half as much as some cr@p insurance plan). This would have two effects: the first would be that insurance companies would *have* to lower their costs to make sure customers don’t leave, and hospitals who *have* to stop gauging people for the privilege of sitting in the waiting rooms. If you like having cr@ptastic insurance plans, then you should be allowed to keep them.

I currently live in a country where health insurance is privatized. I pay about $160/month for my basic, bare-bones coverage…which still covers dental, doctor’s visits, most prescriptions, and if I were to get pregnant again, all my prenatal care and home birth (not that I would have one–but if I elected to have a hospital birth, the cost to me would be a scant few-hundred euros). Our kidlet also has the same coverage, for free until he turns 18.

As for whether health insurance companies and hospitals should go bankrupt…that’s not the right question to ask. Health care should not be subject to the free market, because you have a captive consumer–when was the last time you turned down a doctor’s visit for a screaming, feverish child because it cost too much? People will go to the doctor whether or not they can afford it, and the doctor is obligated to treat them, whether or not they can pay. It gets used, even if the money never materializes. It’s not like buying a microwave, where if you can’t afford the $25 for a cheap one, it’s not the end of the world. If you can’t afford it, it could very well mean your life. This doesn’t mean that insurance companies should go bankrupt–otherwise who else would do the insuring–but it needs to go back to being an ethical business, with higher standards of practice, and to be willing to swallow some losses. Profit cannot be the end-all-be-all when you are in the business of dealing with people’s lives. I suppose the best-case scenario would be the major companies getting together and unveiling a set of standards for the industry. But since that would actually be good for the people, I’m pretty sure we’ll have to wait and see if the next prez can make things better.

Amanda

Expanding Medicare might sounds nice, but when it is already on an insolvent path and we are already $17 trillion in debt, how would that work exactly?

Julius

While I understand the sentiment that health care should not be subject to free market, I don’t entirely agree. For instance if it doesn’t cost anything to see the doctor more people will go for frivolous reasons. When the price is low, people tend to buy more. When doc visits are free people go more often. A study published in Journal Science on expansion of Medicaid has shown that people that were uninsured, but became eligible for Medicaid were actually more likely to use the ER often for conditions that could be treated in primary care. The idea was that Medicaid patients would go to primary care doctors and reduce the flood of people in the ER. Medicaid makes primary care and ER visits free so Medicaid eligible people are using the ER for primary care. Even though ER costs more, the price is the same to the Medicaid patient so they choose the higher cost option as they are insulated from market forces.

The fact is that healthcare, like nearly everything else is a scarce commodity. There will always be more demand than what we can provide. It is a matter of how we allocate our resources. Whether we allow market forces to allocate them or we trust a small group of govt people to allocate the resources or we simply make people wait for services. The US is the only country of 5 English speaking countries studies that had less than 10% of patients wait 4 months or longer to get elective surgery. Elective surgery includes hip replacement, cataract surgery, coronary bypass surgery

We haven’t had true free market health care for many years.

http://expatcatlife.blogspot.com Jules

@ Amanda: Expand Medicare and *give people under the age of 65 the option of buying into it at cost and-a-bit*. No money lost. The reason why Medicare is so cheap is precisely because there is no incentive to maximize profits. It merely has to remain solvent. And whether it will depends largely on how much we’re willing to defund the military, and whether there’s going to be a serious effort to reform Social Security.

As for stifling innovation: MOST innovations in terms of health care come out of academia. Most drugs begin as test compounds, formulated because someone needed a thesis, and most of what gets highlighted in science news are largely funded by public money. I am all for having a healthy pharmaceutical industry, but the fact is, the number of innovative drugs to hit market has been trending downwards for the better part of a decade. The only thing Big Pharma does is patent extended-release formulations of their current “blockbuster” drugs. There is no true innovation coming out of industry these days, because innovation is expensive–witness the billions of dollars it costs to properly test a drug.

I could go on and on about ways to fix the pharmaceutical industry and what needs to happen with health care, but the bottom line is: capitalism only works if power is balanced between the consumer and the supplier. If the consumer *must* buy, the supplier can (and will) screw them over. For this reason, health care should not be subjected to the whims of the marketplace. It may mean that a billionaire or two might have to put up with sub-par hospital food while they’re recovering from their coronary bypass. But it will also mean that a working man doesn’t have to decide whether he can risk going without treatment for another six months.

http://expatcatlife.blogspot.com Jules

@ Julius: You seem to forget that most of the people (if we’re thinking of the same study) were low-income people, who usually work during doctor’s office hours. When are they going to see the doctor, if not in the ER?

You’re right, though, that the true free market left health care a long time ago. But what free market forces that have been operating have wreaked enough havoc. Only in the US could a hospital get away with charging 8X what a surgery costs. Only in the US can pharmaceutical companies market directly to patients. Only in the US could you have an insurance plan that would cut out the moment you tried to make a claim on it.

Amanda

Jules, my father works for a medical disposables company. The man that invented the product they sell isn’t an academic. He’s an entrepreneur. No public money was involved. This isn’t uncommon in his industry. Many innovations come from the private sector.

Julius

Jules: How do you know these we’re working people and how their hours work? How does anyone get to the doctor if they are working during the day. Most do. Besides most places have urgent care facilities for after hours, but these people are going to the ER– far more expensive.

I could not disagree with you more on the free market forces in healthcare. Now we have about 50% of healthcare spending coming from govt (taxpayers) for Medicare and Medicaid. Since Medicare was introduced it’s share of healthcare spending keeps going up, but they don’t reimburse providers as much or in a timely manner as private insurance does. Providers put the burden of paying the bills more and more on private payers (insurance companies). Since ACA Medicare reimbursements have gone down. Some doctors are no longer seeing Medicare patients because they can’t afford it. Hospitals are losing money with the lower reimbursements. At one time, hospitals planned to recover about 60% of what was billed, but I don’t know what it is.

Free-market is less and less a reality for any industry, but look at music players. I was just reading about when CD players were introduced. The companies that introduced them made tons of money (margin) at first, but other companies came in and competed driving the price down. Free market drives prices down.

Look also at LASIK surgery which isn’t usually covered under health plans. It is successful at reasonable costs. Everybody pays a market price. You don’t have half paying an artificially low govt. price, while the other half pays an artificially high price.

Julius

Amanda: Google (actually use Bing) but look up Commonwealth Fund which did the study Stacey linked. They’ve been putting out pro-ACA studies for a few years. I am not going to look at methodology here, but I wouldn’t draw too many conclusions from one study on wait time particularly if they have an ideological view.

http://expatcatlife.blogspot.com Jules

@ Julius: How can you be so sure that they’re not? I was thinking of what happened in Oregon, where they expanded Medicaid to cover some 25,000 low-income people. The kinds of jobs that fall under that category aren’t exactly the kinds that are forgiving if you want to take some time off to see the doctor.

As for Medicare and the free market: I totally agree with you–the effect of the free market should be to drive prices downwards. But this isn’t what’s happened, and the reasons why–CYA testing, extraneous procedures, etc–are largely because of the unholy collusion between the providers and the insurance companies. But Medicare CANNOT pay market prices for things, because that would be wasteful. As a government program, it is supposed to help cover the COST of care, not help hospitals turn a profit. My quick perfunctory scan of the Internet says that 80% of Medicare are covered, with the remaining 20% charged to the patient.

But the main reason why free market models don’t work for health care is because, as I said above, it doesn’t matter if you can afford it. Doctors are ethically obliged to provide it, and people who need it will use it, even if they can’t otherwise afford it. There is no way to balance the power of insurance companies and hosptials if you’re the one begging them to pay for your chemo.

Danielle A

Health care in the US is terrible. Period. Aca or not, it will never be good. This has nothing to do with who the President is, it’s just how the system works and it can’t change because the billionaire CEOs of “insurance” companies are not going to go away. But people need to get a clue before they say that it’s worse now. At least now people can’t be denied for pre existing conditions, or get dropped for getting sick, old, getting pregnant or being a woman.

Leah

@ Julius comment #8, regarding how little profit insurance companies make. I’ve seen anywhere from your choice of 3.3% way up to 12%.

And even if it is “Just” 3.3% – 3.3% of a millions and even billions of dollars is an obscene amount of profit.

Insurance companies are working every angle of ACA to make themselves even richer. We are the country where the rich stay rich and the poor get poorer and middle class does not exist.

Nenya

Allow me to give you some facts about healthcare in the country I reside in, Germany:

* I pay about 300 EUR per month for my health insurance.
* If I call a GP for an appointment, I get one for the same day, or the next day if necessary. If I call a specialist, and I have been referred by my GP, I will be seen within a week. If I call a pediatrician, my daughter will be seen within 5 hours.
* You pay $15 every quarter to go any doc. And that is IT.
* If uninsured, an emergency room visit costs you 30 EUR ($35).
* Meds cost you between 5 and 10 EUR, unless they are prescribed for a child. Kids’ meds are entirely free.
* All maternity-related medical care is covered by my insurance provider, except maybe the “family room” (where an entire family can stay together during the post-labour period).
* My insurer notified all his policy-holders that, due to making too much profit, he will be issuing each insured payer an 80 EUR refund-cheque, due to arrive in March.
*I also have paid maternity leave AND parental leave, but that’s covered by the state, not by my insurer, so it doesn’t count.

Now, all this to say_ I consider the arguments about how public healthcare is “too expensive” and how the free market is the only “good option” to be PURE GARBAGE. Here is an example of a system THAT WORKS, where private and public companies coexist to provide coverage for the entirety of the country.

In my opinion, the problem with the US healthcare system is what Jules stated when he/she said ” If the consumer *must* buy, the supplier can (and will) screw them over.”
Healthcare is a market that is by nature not free: it is an oligopoly. Not everyone can become a healthcare provider: there is a pretty steep cost to enter this business arena (personnel training, equipment, facilities etc). If the market for providers isn’t free, then the few who can enter it are free to become price-givers, or setters. In short, they become a cartel. Does anyone need me to explain why profiteering is the inherent purpose of any cartel?

Amanda

Leah, then I guess almost everyone I know doesn’t exist if the middle class doesn’t exist. Go figure. Seriously, though, that is a ridiculous view of America.

After literally years of being without insurance, my husband got a new and better job and his insurance started right around the time that we would have been eligible to apply for ACA, so we didn’t bother. However, it is absolutely beautiful knowing that should his job fall through we will have an insurance option. Some friends of mine also use ACA and it has been a huge life changer. Many of them have medical conditions like asthma, diabetes, PCOS, Depression, etc that are appropriately treated for the first time in years.

I know a lot of people are coming out of the woodwork in general to claim ACA is the worst thing EVER and will be the expensive downfall of civilization, but from where I sit it is literally saving the lives of actual people that I know… and preventing people from having to declare bankruptcy due to medical costs. I’m hoping it’s the first step toward socialized medicine in the USA. I grew up not seeing the doctor for very serious things as a kid because we didn’t have insurance and couldn’t afford it. I’m looking forward to a future where no kids in the USA are in a similar position, where nobody has to decide between paying their heating bill and going to the doctor to treat their pneumonia/broken leg/abscessed tooth.

http://YZYDX2 Ridley No. l

Stacie: The waiting times for “Specialists” can be very long. Perhaps because many of our doctors who were educated in top medical schools have departed Canada to work in the U.S. where they are able to earn huge salaries. And did you know about the level of fraud from Americans coming into Canada, obtaining stolen or fake Canadian Health Cards, getting various free services with our Canadian tax payer dollars…… And of course Canada is such a “suck” – so many entries claiming to be regugees who immediately receive the free health care the moment they step onto our soil…. Now that can make one “sick”….. Recently I had to take my 4 yr. old grandson to the Paediatrician. The (working) Mommy had temporarily misplaced his Health Card. A $75.00 fee had to be paid before the little man could be examined (and he was not “very ill” or anything., but as the Desk Clerk explained she could not process his visit without the special code number on the card which would have to be “swiped”….However, despite some annoyances, living here in Canada is still the best (or maybe “almost)….. And you, my dear, are indeed fortunate that your unfortunate recent bout with such a devastating illness did not wipe you out financially. I know that the U.K. provides top medical care. The hospital you were in is highly rated, as was May’s hospital for her recent surgery.
From what I know – Australia is the absolute best place to reside with their phenomenal medical care…… Don’t imagine you would want to return to reside in the U.. with such Uncertainty about your health care.

Julius

Jules: those test and procedures are often done to avoid lawsuits. However, market forces do not allow them to happen, because it is the insurance company that pays the bill (or Medicare). It doesn’t cost the patient anything extra to have a bunch of tests done. The doctors like to do it to protect from malpractice, and insurance pays for it. If they don’t pay than people on Forums like this will yell at them. Tory reform was rejected when they passed the ACA.

As for the Medicaid study. The fact is that once free ER visits went up. Not everyone works all day. Medicaid was supposed to cut costs by providing access to primary care physicians. That didn’t happen and it means the ACA was more expensive than necessary. No speculation on working hours undermines the basic premise that when something is cheaper people use more of it.

Julius

Jules 18. This is going around in circles. You are dismissing a study because you assume that the people in the study all work during the day and thus don’t have the time to go to the doctor. If that’s the case than Medicaid surely isn’t the problem.
but the crux of what I said remains true. medicaid now makes ER visits free so now more people are using the ER for minor issues that could be addressed by Primary Care. Taking market pricing out of the scenario encourages people to find more costly solutions.
No amount of speculation as to the nature of their employment or their mode of transportation or whether or not they can get away to go to the doctor will take that away. Seriously to hear you tell it the first thing we should have done to improve health care is give everyone a day off during the week to go to the doctor. I suggest that you take this up with the lady from MIT who did the study and said the same thing, that if you make something cheaper people take more of it.
Leah#20. you might see varying numbers as percent of profit margins vary depending on what they are defining. Mine was for offering health care insurance plans. Some other items in the health care industry do have higher profit margins/
But then I ask why should these companies not be allowed to make a profit?
If you decide that it is immoral at all to make a profit in insurance than consider that someone has to do the work on health care plans. So under govt. care like Medicare, you will have more people in the govt. doing exactly what insurance companies do. But then we should ask does govt administration of healthcare cost less than private (insurance company) + profit margin.
The post office is far less efficient than Fed Ex. Govt is not known for being efficient. If it was the healthcare website would not have been the disaster it was.
Would the quality of administration of health care plans be better? Probably not when you consider doctors struggle with Medicare as it is.
If you are morally opposed to companies making money on healthcare, I hope you don’t get any of your daily needs from any of the other companies listed above health care on the list of profit margin. After all we need food to survive, places to live too. Those people can make a profit.

Doing away with profit sounds lovely, because the assumption is that those resources would be put to better use. However, there is no reason to believe that that would happen. Instead of allowing different groups to compete and offer more for less, you just leave all the decisions to one group that doesn’t have to improve or reduce costs because there is no one competing with them to prove that you can do better. A government monopoly of health care administration is then forced on all of us wtihout any recourse if they dont do a good job. Without competition, people are left with no clue that they are getting crap service because the govt. monopoly is the only thing anyone knows.

I do agree that insurance companies are working the angles to make more money. All companies do that. That doesn’t mean they aren’t more efficient. You see top insurance companies worked with govt on ACA anticipating many more customers. And authors knew that what they were doing might make insurance premiums go up because they incorporated a bailout for them if they don’t get enough young healthy suckers to buy expensive health plans.

Julius

Sorry Jules I double posted you.

Faith

Julius, just because a company has thin margins doesn’t mean they don’t make money–and it certainly doesn’t mean they aren’t paying their execs handsomely. The median income for a CEO of a health insurance company in 2012 was $11 million. The CEO of United Health Group, Stephen Hemsley, received $106 million in a combination of cash and stock options.

By comparison, Amazon is another company with razor-thin margins. CEO Jeff Bezos’s compensation in 2012: $81,840. If you include travel expenses and security, it bumps it up to $1.68 million.

Apple paid Tim Cook $4 million in a mix of salary and a cash bonus. Including stock options, he earned $40 million in 2012. That’s still less than half of what Hemsley made last year–and Apple’s margins are 37%.

When comparing the executive pay of the heads of insurance companies with those of technology companies–yes, insurance companies look pretty damn greedy.

Jenna

I personally feel like while we think Obamacare will bankrupt us, which I’ve heard, I, too, think that it will end up being a good thing. The thing is, right now, we really don’t have access to any other insurance than the one our companies provide us with, if they provide it at all, and even then, we don’t have a choice on the inclusions that policy entails. It is completely insane to me that some people can pay $800 for a family of 5 to be insured and another person can pay $250 (both of those are my own examples of two separate companies I worked for, both large companies, both paid well and I am an educated person who got paid well for both jobs). We only think we have freedom with choosing insurance, but we don’t and never have. And yes, hospitals, doctors, etc. will charge insurance for as much as they think insurance will pay. There are no set standards for how much any procedure will end up costing. I recently had a one night stay in a hospital for a severe case of strep throat and sinus infection, I had two rounds of anti-biotics, and was there for about 36 hours. The hospital tried to charge my insurance $60,000. I also recently had a breast reduction approved by insurance, they tried to charge my insurance $300,000. Of course, my insurance won’t end up paying that but even still, it’s unbelievable. No wonder medical care in this country. But, I do think people forget how things like this always go, we always think it’s a horrible idea until the system starts to realize the benefits of it and it becomes the standard. Medicare is a great example of that. I am also thinking, possibly, the more people will be free to leave jobs and open their own businesses or go into business for themselves because the option of healthcare is available for them??

Stacie Lewis

Wow, I’m astounded by those numbers Jenna.

http://expatcatlife.blogspot.com Jules

@ Julius: I finally found the Medicaid paper you’re referring to, and some commentary to go with it, since I can’t access the paper. The researchers apparently went to some lengths to explain that the reason why people went to the ER…was because they’d always gone to the ER. They simply didn’t know any better. Many of them were also referred to the ER by their (new) primary care physician, mostly because the PCP didn’t have the time/resources to do the treatment. Which opens up a whole ‘nother can of worms…

But in any case, I very much doubt any of the people in the study decided, “Hey, this is great, let’s go screw over the system by using the most expensive form of health care!” I doubt any of them would have known how to look up prices at the ER versus prices at the doctor’s. What the Medicaid expansion did was give people an opportunity to see the doctor without worrying about the cost. So they did. That they elected to continue to use the ER apparently has more to do with indifference/apathy than a malicious attempt to screw over the system. (As for whether they use more health care–you’re talking about people who may have had chronic health problems that they couldn’t have addressed for years. Of course they’re going to use more.)

And just to be clear: I don’t think there’s anything wrong with companies making a profit. If they have a good year, selling a good product that people want to buy, great! But making a profit should not be the goal of companies that deal with health and human lives.

Natalie

The thing that really amazes me is that most of the people who are raising hell about the new ACA, are people with amazing healthcare through an employer. They don’t understand the other side, where you don’t have insurance and are scared about how to survive if anything medical should happen to you. My mother went without health coverage for herself for 5 years until she was old enough for Medicare. She set her own sprained finger, looked up treatments on the internet and gave up her asthma meds because she couldn’t afford it. And no, she doesn’t live in the slums, she lives in a nice middle-class neighborhood. But she and her husband are self-employed and private insurance for someone over 50 was impossible to get. I also had the situation where I was pregnant with my second child and we were so worried about getting coverage for her after birth. My plan covered only me and my husband’s plan covered only him, but to buy a private plan for the baby, it wouldn’t come into effect until 30 days after she was born. So I just hoped and prayed that she wasn’t born with any problems.

Do I think the program is perfect? No, but we have to keep trying to make things better. I have hope that it will work out the kinks over the next few years once people give up trying to get rid of it, and work together to make it better.

Stacie Lewis

I’m really glad you shared this because people forget how unjust it was. It’s criminal that a baby wouldn’t be covered until 30 days post-birth. I hope they smooth out the ACA so that more people feel they are also getting a fairer deal.

Jane

Amen Natalie! And Julius, for every “frivolous” trip to the doctor’s office, there’s another trip that will reveal that the mole is cancer or the cough is actually pneumonia. I’m not too worried that Americans will start running to their doctor for a hangnail. I’m relieved that people who before waited till the issue was worthy of an emergency room visit will now be able to access a doctor to catch these problems earlier when they are treatable.

Julius

Jules– when did I say that people go to the ER out of malicious intent?

Julius

Jane– i’s totally support your last comment if we had unlimited resources for healthcare. Even socialized medicine has to allocate resources. So frivolous trips to the doctor are fine with me as long as everyone gets care. Once the wait lists start piling up–count me out.

Jane

Julius, what trips to the doctor are frivolous? Unless a person has a serious mental health issue, perhaps diagnosed hypochondria, people are pretty aware of when they need to go to the doctor. Who wants to make an appt, sit in the waiting room and then be prodded for no good reason?

The number of people who would catch diseases in the early stages would save lives and costs down the line.

http://YZYDX2 Ridley No. l

The great thing about my Family Doctor is his affiliation with a Team of Doctors who cover for each other at their After Hours Clinic…. We just call AFTER 4 pm on a week dkay and as long as we are listed as patients, one of these doctors (including my own) will see us at a specific time – such as maybe 6:30 pm or whatever……. I only just learned this valuable information. There are also numerous Walk-in-Clinics during week-days and week-ends, but I don’t like sitting with a room full of sick people with colds and flu…… so what my Family Doctor and his associates are offering is a good solution. To be stuck in an Emergency Room at the hospital is dreadful….. 0bviously, you wait and you wait and you wait if you are not critical such as a gun shot wound or a heart attack, etc. And this costs the Government even more $$$$$$…. I spent time visiting with my Florida relative and had to take her to the Emergency Department, Let me tell you – the wait times there were really long – no different than with our Socialized Medicine here in Toronto. Can’t say I was impressed with her care in the hospital, but when I accompanied her to a couple of Specialists appointments, it was swift and seemingly efficient, as long as she had the credit card handy, but money doesn’t always buy you health. The 0bama Plan sounds rather vague – maybe they’ll figure it as time goes along, with many bumps in the road.

Jenna No. 30: Wow!!!! The hospital wanted to charge your insurance co. $300,000 for a Breast Reduction!!!! I had a Breast Reduction in 2006, stayed overnight in hospital with a charge of $5 or $6 for use of telephone. The Surgeon had to send in a completed form describing my back problems, shoulder & spine. He did not feel is as a Cosmetic procedure. As it was elective surgery, I did have to wait quite a while, but happily lost some weight in preparation. So folks – Canadian Socialized Medicine does have some advantages. At least I got a perk with all the money I pay in Taxes! (By the way: no one stays in hospital these days for Breast Reduction surgery… now it’s Day Surgery, with a few hours in the Recovery Room. My sister-in-law just had the same necessary surgery – is she ever happy.)

Lucy

The ACA has not helped our family AT ALL! My husband has worked at the same job for 11 years. When he first started we had great insurance that the company paid for. But, it started to decline about 5 year ago. We thought it was really bad last year. The company only offered a High Deductible plan and provided minimal help with the premium. We had a $4000 deductible and our premium was $450/mo. It was hard and we really questioned if we should even bother keeping it. We did not even come close to meeting our deductible at the end of the year. And, the only thing that was actually paid for by the insurance were 4 well child checkups, vaccines and my pap smear. I would have been much better off just paying out of pocket for those! This year everything is MUCH worse. Our deductible shot up to $6000 and our premium is $978/mo! My husband only made $30,000 last year…so our insurance is going to cost us more than half of his income! We ultimately decided to opt out because we can’t afford to pay for it…but because he is has the ability to buy insurance through is work, we can not get coverage through Obamacare. I think the ACA will help some low income families…but it is ruining those of us who are working poor. We would be financially better off if my husband quit his job, found a part-time one with no benefits and we took advantage of all of the government aid we can get!

Amie

While my husband and I earn too much to qualify for the credits that others may get, I went through the process of the NY State enrollment for my husband and 2 yr old son. Why? My husband was laid off and it was over $850/month for him to continue his coverage that also covered my son. Adding them to my work coverage would be more than COBRA. End result? The coverage for both of them was just slightly over half of what COBRA costs. My husband started a new job that excludes him for the first 90 days+ (it won’t start until 90 days have passed and it ends up starting the 5th month from our calculations). I examined the coverage and I don’t think it’s really that different from what we had before. Granted, we live in the NYC metro area and there are plenty of providers here so … I’m putting the “savings” into our toddler’s college plan. End result? I’m happy with the premium.

Jenna

Lucy – in my opinion, eventually, and I know it doesn’t help now, but eventually, ACA will alleviate these problems because you will pay a premium based on your salary. I totally think this is the reason it’s good in the first place. Those people who get paid a little more than the lowest but much lower than the highest end up paying the most for premiums. I was getting paid $11 an hour and paid about $900 a month, which was just insane. But my husband and I made too much money to qualify for Chips at the time (I was pregnant). So, I think the idea of having insurance all the time, without the thought of it being tyed to a company is awesome. I am serious, I do not know who decided our employers are responsible for our health insurance, anyway. Well, I do know it was a perk at one point, to recruit the best employees, but now it’s become ridiculous how the system is reliant on our employers to pay our insurance premiums. this is another reason our health care is so high.

Sandra

I’m totally with Jules on this. We had functioning very good and relatively inexpensive programs that were working *well* for the people *they covered (Medicaid, Medicare, WIC). That we should have done is simply expand those programs to cover more people.

I also push for health care coverage for all, but I think the ACA was a big mistake. We have also got to take a much much closer look on the aid we send overseas. It makes NO sense that a country we are giving aid to, uses that aid to buy parts of our debt (so that we essentially owe them money, even though we give THEM aid). This happens far more often than people are aware.

I am very very concerned about the state of US finances. very concerned.

Julius

Jane: You responded to my complaints about people using the ER for basic issues that could be covered by primary care, with the idea that each of these visit could uncover a serious illness, which is true or it can not be true. Either way, I am not for going to the ER for stuff that can be covered in primary care office. People genuinely concerned about health care resources and access should compare that.

I get the feeling you want me to list a serious of situations where people might go the doctor so that you can point out a serious illness implied by these. If the very idea that there can be a frivilous trip to the doctor’s office is unreal to you, than we won’t have any common ground.

Having said that people go to the doctor to get antibiotics anytime they have an illness–doctors don’t like this. People go to the doctor because they like the attention. People go to the doctor because it’s free and why not have the muscle strain checked out because it’s free. Why not.

Julius

People say that Obama had good intentions and this was the best he could do given the fact that republican are (insert insult here). However, there was support for health reform to increase access on both sides of the aisle. There was even a bill languishing in the Senate, Wyden-Bennett. I don’t know anything about this bill. ONly that it increased access for health care and had support from both republicans and democrats.

When the full scope and impact of ACA became apparent, Obama lost Republican support. Even when voters of MA voted to elect a Republican Senator, they pushed ACA through with reconciliation process.

For the record, I am super right wing, and I am not sure I would have supported some of those republican proposals, but I think it is worth noting that there were other options besides ACA.

And Sandra, the finances of this country are one thing that I would agree with you wholeheartedly on. It used to keep me up at nights. I’d calculate how much my kids owed already and wish that I could donate everything I have to get them out of the financial hole. That isn’t realistic. So here I am.

Jamie

People who think others make “frivilous” dr appointments – I’m assuming they are just typical Republican-hate-anything-Obama-does-even-if-it-helps-others.

Those who go without basic healthcare for years due to lack of insurance certainly aren’t making frivilous appointments. Nor would they. They may have a a lot of “catch up” appointments, but not frivilous. And what on earth is a “frivilous” dr. appointment? Something someone who does not support ACA made up or determines. Just the term frivilous dr. appointment is the most ridiculous thing I’ve heard in quite some time.

I am lucky enough to have affordalbe benefits through work. Before that I spent my 20s without healthcare and it was hoorible. I had to choose between eye exams and food, medicine or rent. I have many friends working 2 and 3 jobs who until ACA could not afford healthcare. My own sister was putting off having children because it was not covered by her insurance can now plan a family thanks to ACA.

alicia

Jamie – more people are losing their health insurance under Obamacare, than are gaining it. Just because Republicans think with their heads, doesn’t mean we are heartless. Just because Obamacare seems like a warm and fuzzy idea, doesn’t mean it is actually helping more Americans than it is hurting.

Jamie

Alicia – please show an acutal link stating the number of people who are losing their insurance due to ACA (as opposed to those who are losing it due to fat cat insurance companies working any angle to boot people off).

And the vast majority of self-proclaimed republicans aren’t thinking with their head -they are just towing the party line of anti-everything-Obama.

ACA is not “warm and fuzzy” – it is a major benefit to citizens of this country. and it I find it very telling about the character and mindset of anyone who thinks that affordable insurance for ALL citizens is simply “warm and fuzzy”

Julius

Jamie: I am sorry that you did not know that so many have lost coverage under Obamacare. It has been widely reported. Here you go.

Actually this will get worse as the administration delayed having employers plans meet ACA requirements for one year. If they hadn’t done that than even more would have lost jobs. (As we are supposed to be a nation of laws it would have been good if Obama had worked with Congress to implement the delay before changing the law on a whim)

Your comment about the vast majority of republicans only acting out of anti-Obama sentiment is both hostile and insulting.

Julius

Correction: more would have lost coverage not jobs. Although employers are avoiding Obamacare by moving people to part time jobs hurting the very people this law was meant to protect.

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